This proposal responds to the NIDCD special solicitation RFA-DC-12-004 for improving access to hearing healthcare. In particular, the NIDCD is seeking solutions to lower the cost of hearing healthcare and improve access for underserved populations (such as the disabled and communities with limited resource access). Technologies that achieve the initiative objectives include telehealth technologies for remote evaluation and monitoring, devices for in-home monitoring, mobile and portable assessment systems, and devices that do not require special training and can operate in low-resource environments. Distortion product otoacoustic emissions (DPOAEs) offer many advantages over other forms of hearing assessment: they are a sensitive objective screening tool with good test-retest reliability for screening; they can be used with children and adults of all ages; and they are a fast, efficien computerized screening method. However, DPOAE measurement systems tend to be significantly more expensive than screening audiometers (5 to 10 times as much) and they are susceptible to noise caused by the instrument (either from the person holding the system if it is handheld, or from the cord rubbing on the patient), as well as biological noise. Creare proposes to develop a low-cost (<$1000), mobile, user-friendly otoacoustic emissions (OAE) probe with adaptive noise rejection and noise reduction for hearing screening. Adaptive noise rejection and noise reduction algorithms improve the SNR by at least 10 dB even in noisy conditions. Our proposed innovation will increase access to hearing health services by allowing low-cost hearing screening for children as well as adults with intellectual disabilities, and it will enablethe monitoring of noise induced cochlear damage for noise exposed patients who may not have easy access to such screening technology, in particular, miners, farmers, and other noise exposed workers who live in remote locations. Finally, a mobile-based OAE probe will find wide applications in low resource countries leveraging the cellular network with a battery-powered instrument to conduct infant and childhood screenings.